摘要:

Severity of illness must be quantitated in critically ill patients if studies of outcome and therapeutic efficacy [are to be meaningful. Objective physiologic indicators of critical illness, such as pertinent laboratory values, can be quantitated using the Therapeutic Intervention [Scoring System—TISS. TISS data were obtained for 199, consecutive Class IV critically ill surgical ICU patients and compared to the same data obtained in less critically ill Class II and III ICU patients who served as the control group. For the physiologic indicators of critical illness, a wide range of normal values was established prospectively. The actual values generated by Class IV patients were compared to values of the same indicators as measured in Class II and III ICU patients.Of all objective indicators of critical illness, 55% were either outside the normal range or more than 2 SD away from the mean value of objective indicators for [Class II and III ICU patients; 49% were beyond the normal range or more than 3 SD away. Of all TISS indicators, 73% were abnormal, and 36% of all physiologic indicators were still abnormal despite massive therapeutic support when compared to Class II or III ICU patients. Those patients who had more than 40% of; their physiologic indicators abnormal were more likely to die. However, the percentage of abnormal TISS indicators did not discriminate between patients who died and those who lived, because almost all patients received massive support.These results demonstrate the extremely abnormal physiology and the need for massive support in Class IV critically ill patients when compared to other types of, ICU patients. Because conventional care protocols preclude support systems necessary to maintain life, let alone institute specific therapy required by these critically ill patients, it is unlikely that these Class IV patients would have survived their critical illness in the absence of intensive care facilities and resources.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Long-term (> 48 h) sodium nitroprusside (SNP) infusion significantly reduced cobalamin (vitamin B12) levels in 23 patients treated in a CCU after myocardial infarction. There was no evidence of vitamin B12deficiency or SNP toxicity. Low vitamin B12levels should not limit the use of SNP, because prolonged infusion of SNP at maximum doses of 2.5 μg/kg·min did not adversely affect hemodynamic stability.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A total of 2711 pulmonary artery wedge pressure (WP) measurement attempts were made prospectively from WP recordings in 44 (30 men) critically ill patients, using 77 flow-directed catheters. Of these, 322 (12%) failed to yield a WP measurement, and 521 (18%) were associated with technical problems. One half of these technical problems were due to poor dynamic response or damped pressure tracings; other problems included balloon overinflation, partial WP, and inability to aspirate blood from the pulmonary artery (PA) port. Only 50% of wedge blood sampled at the time of initial PA catheterization yielded capillary blood (Po2ge; 10 torr higher than Pao2). In 12 stable patients in whom paired measurements were available, there were clinically important differences (-13 to +22 torr) between paired WP measurements made before and after rapid correction of technical problems. Technical problems are common and may be associated with clinically important errors. Those due to poor dynamic response are easily and rapidly detected at the bedside.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This study is a therapeutic evaluation of prolonged immobilization and controlled intermittent positive-pressure ventilation (IPPV) after global brain ischemia (GBI) in pigtailed monkeys. Sixteen min of GBI was produced with a high-pressure neck cuff, while the lungs were being continuously ventilated. Normotension was restored within 2 min postischemia (PI). The control group of 13 monkeys was weaned from IPPV 4 to 6 h PI. The treatment group of 18 animals was paralyzed and ventilated with a 50:50 nitrous oxide-oxygen mixture for 48 h PI. Intensive care was maintained for 96 h PI. In the control group, 8 of 10 animals were awake at 96 h PI compared to 7 of 11 in the treatment group. Neurologic deficit scores for the survivors in the 2 groups were also not significantly different. Histologic examination supported this conclusion. Paralysis/IPPV for 48 h post-GBI with 50% N2O facilitates control of blood gases and blood pressure, but does not improve the neurologic outcome over that achieved with only 4 to 6 h of controlled ventilation.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The end-tidal carbon dioxide tension (PetCO2) measured after a single, large tidal-volume breath (15 ml/kg body weight) was compared to simultaneous measurements of Paco2in 6 dogs with normal lungs who were receiving high-frequency jet ventilation (HFJV). There was an excellent linear correlation between Petco2and the Paco2over the entire range of CO2tensions commonly encountered in clinical practice (Petco2= 0.9 Paco2+ 2.2 torr; n = 51, r = .98,p< .001, range of Paco2= 12–72 torr). We conclude that when lung function is normal, a simple system of measuring Petco2after a large breath is an accurate method of monitoring the effectiveness of CO2elimination during HFJV.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

In the critically ill patient the monitoring of oxygen consumption (Vo2) and carbon dioxide production (Vco2) can identify abnormalities in tissue perfusion and metabolism. A patient's metabolic utilization can be calculated by indirect calorimetry, once Vo2and Vco2are measured. This paper evaluates a compact instrument designed for monitoring Vo2and Vco2in the critically ill adult. Accuracy was measured under controlled laboratory conditions using oxygen-enriched air, PEEP, and intermittent mandatory ventilation (IMV). Accuracy averaged 1.3% for Vo2and 0.9% for Vco2when room air was used. Accuracy was 11.7% for Vo2and 6.8% for Vco2when 80% oxygen was used. PEEP of 30 cm H2O had little effect on accuracy. IMV at 2 breath/min (room air) resulted in an accuracy of 4.0% and 4.1% for Vo2and Vco2, respectively.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The urine glucose concentration is commonly used to monitor indirectly the degree of hyperglycemia in critically ill patients and to adjust insulin dosage. Most commercially available urine glucose reagent test strips measure the urine glucose concentration from 0% to 2%. When the urine glucose is at the 2% level, the blood glucose concentration may vary over a wide range. We compared a new urine glucose test strip which measures the urine glucose concentration from 0% to 5% versus a conventional strip (0% to 2%) in the analysis of double-voided urine specimens from 285 patients with diabetes mellitus. Both types of test strips were insensitive in detecting hyperglycemia and showed a wide range of blood glucose values for each estimated urine glucose concentration. However, the new test strips which gave measurements at the 3% and 5% urine glucose concentrations allowed for more specificity (99%) in detecting blood glucose levels above 250 mg/dl. We conclude that: (a) test strips measuring from 0% to 5% are superior to conventional 0% to 2% test strips because the 3% and 5% urine glucose readings allow for a high level of specificity in detecting severe hyperglycemia (≥250 mg/dl); (b) urine glucose testing is insensitive and nonspecific in detecting hyperglycemia when urine glucose values are 2% or less.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Nosocomial pneumonia occurs in 0.5% to 5.0% of all hospital admissions and is responsible for 15% of hospital deaths. Up to 60% of ICU patients may develop pneumonia, depending on the severity of their underlying disease. Despite the availability of potent antibiotics, ICU patients who develop Gram-negative pneumonia have a disturbingly high mortality rate. Specific etiologic diagnosis is frequently lacking because microbiological samples are commonly contaminated by oropharyngeal secretions which are colonized by Gram-negative bacilli (GNB) in up to 100% of ICU patients. Great controversy surrounds the value of various methods used to diagnose nosocomial pneumonia. Clinical criteria of pneumonia include fever, leukocytosis, purulent tracheobronchial secretions, and a new infiltrate on chest x-ray—all of which are also frequently observed in patients free of pneumonia. Tracheobronchial secretions are often contaminated by microorganisms colonizing the upper airways and their examination may provide misleading information and result in patient mismanagement. Blood cultures are valuable but positive in only a small proportion of patients with nosocomial pneumonia. Transtracheal and transthoracic aspiration are unsatisfactory in the intubated patient requiring mechanical ventilation. Immunologic techniques like countercurrent immunoelectrophoresis are promising but presently inadequate to screen for a wide variety of organisms. Transbronchial or open-lung biopsy may be considered if the pneumonia is thought to be due to opportunistic organisms rather than bacteria. From a practical standpoint, the least misleading information is probably obtained by quantitative cultures obtained from the lower airways by fiberoptic bronchoscopy, employing the plugged telescoping-catheter brush technique.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Polyuria, peaking at 2000 ml/h, was seen in a patient after resuscitation of hemorrhagic shock and a brief period of oliguria. This unusual polyuria appears to be a consequence of renal tubular dysfunction that persisted after glomerular filtration rate had returned to normal.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID